Tuesday, November 03, 2009

Drugs and scientists

Drugs are in the headlines again. Professor David Nutt, Chairman of the body advising the government on the misuse of drugs has been fired for campaigning for the legalisation of certain drugs like Cannabis and Ecstasy. He had previously advised the government that Cannabis and Ecstasy were less dangerous than tobacco and alcohol; advice which the government rejected.

The issue is a complex one. If a government appoints you to an Advisory Council, have they bought your opinion? Clearly if you worked for Roche and you went around campaigning against the use of Roche drugs, they would be right to fire you, but the government only pays you for a day a month, surely your opinion is your own for the rest of the month. No. If your opinion is different from the government's and you voice it about, then they have every right not to employ you again. Let's be clear, scientists get a lot of kudos from chairing government committees. Sometimes they get a CBE or other award for doing so. If Professor Nutt says something, nobody listens, especially with a name like that, but if the Chairman of the Drugs Advisory Council says something the Government disapproves of then everybody listens.

But shouldn't an expert scientist's opinion be listened to? I have some sympathy with this point of view. After all, science is very hard. Students study the humanities rather than science in many cases because they can't do the Math. In the humanities, as the post modernists have told us, there is no correct answer, only opinions. You can't be post-modern about 2+2=4. The problem is that scientists are human too. Science varies. Mathmatics may be very pure, but in the applied sciences intellect is contaminated by emotion. It took many years to convince people that smoking causes lung cancer. Why? Because many people didn't want to believe; they liked their cigarettes. I have no idea whether Professor Nutt smokes pot at the weekend or whether he did at University, but if he did and he enjoyed it, his way of looking at the evidence might be a bit selective.

If a new law were to take pennies from your pocket, your view of it might not be objective. Who believes the evidence of the oil companies on global warming? Who believes Greenpeace on the virtues of vegetarianism? When we look at clinical trials, we know that some trial evidence is smothered at birth because it doesn't give the answer the pharmaceutical companies wanted. So who is doing the smothering here, Nutt or Brown?

An article in today's Times suggests that Nutt hasn't done the science correctly. The author, Robin Murray, is Professor of Psychiatric Research at the Institute of Psychiatry, King’s College London and a specialist in schizophrenia. He believes that Professor Nutt underestimates the risk of cannabis users developing schizophrenia. He states, "In his lecture last week Professor Nutt contrasted a 2.6-fold increase in the risk of psychosis from using cannabis with a twentyfold increase in the risk of lung cancer if one smokes cigarettes. Unfortunately he was not comparing like with like here. The twentyfold increased risk does not come just by being a smoker but by being a long-term heavy smoker. For cannabis, the risk of schizophrenia rises about sixfold if one is a long-term heavy user."

David Nutt is also a psychiatrist, in particular a neuropsychopharmacologist specialising in the research of drugs which affect the brain and conditions such as addiction, anxiety and sleep. He is a professor at the University of Bristol heading their Psychopharmacology Unit and also holds the Edmond J Safra chair in Neuropsychopharmacology at Imperial College, London. So we have two eminent psychiatrists falling out over the effect of drugs on the mind.

The point is that psychiatry is one of those half-sciences like economics. It is still permissable to have opinions about things.

Margaret Thatcher once said, "Advisors are there to advise; it's up to politicians to make decisions." The problem arises when politicians try to wriggle out of the decisions they have made.

On the substantive issue of whether illicit drugs should be legalized there are differing opinions. Prohibition of alcohol was tried in the USA for several years and is generally held to have been unsuccessful. Supply of alcohol became criminalized and many ordinary people broke the law with impunity. Lack of respect for the law may have been a long-lasting consequence. Many argue that the same situation exists today with drugs. Supply is by criminal gangs. Much police time is spent trying to enforce the law. Prisons are filled with drug addicts. Middle class people ignore the law with impunity.

Although banning alcohol didn't work, neither did unbanning it. More people die from alcohol-related diseases than ever before. The social consequences of alcohol abuse - wife-beating, poverty, child-neglect, public order offences, violence on the streets, football hooliganism, motor accidents, murder and mayhem - are there for all to see. Tobacco consumption is decreasing, but it has taken nearly 60 years since the first evidence linking smoking with lung cancer appeared. Price hikes, advertising bans and public education campaigns have still left is with one man in five smoking.

We do not have long term studies of people who take Ecstasy or Cannabis. Although legalising drugs might have some benefits - less spread of viruses, less contamination of the drugs that addicts take and even tax revenue for the government - we really can't begin to count the downsides.

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Born in Worcester, England 1943; school at Farnborough, Hampshire 1954-62; University 1962-7 and junior doctor posts 1967-74 in Bristol; Consultant Haematologist Bournemouth 1974-2003; Professor of Immunohaematology Southampton 1986 to present. Honorary Consultant Haematologist Kings College Hospital, London, 2004-present. After 5 years of working part time researching, writing, reviewing, editing, speaking, sitting on committees, advising, answering questions and thinking, I now think of myself as fully retired apart from my role as Editor in Chief of the medical journal Leukemia Research. I was awarded the Binet-Rai medal for outstanding research in CLL in 2002 and this has been my most sucessful area of research, but I have also made important contributions in the fields of apheresis, stem cell transplantation, myeloma, myelodysplastic syndrome, antibody therapy, cytokine therapy and DNA vaccines. I was once mascot for Aldershot Town Football. Club. Married to Diane for 44 years. Four children, Karen, Richard, Angela and David.